Foot deformity with displacement of the big toe and protruding bones is one of the most common orthopedic pathologies.At first, the disease manifests itself as a cosmetic defect and does not cause any special problems, but if it is not treated, it develops with age.Feet quickly tire when walking, pain begins, problems with choosing shoes arise, and it becomes increasingly difficult to correct the deformity even with surgery.Therefore, start treatmenthallux valgus (foot valgus)necessary as soon as the first signs of the disease appear.
Causes of hallux valgus
This is a multifactorial disease that develops due to hereditary predisposition, other diseases of the musculoskeletal system, neurological pathology and metabolic disorders, and external factors.
Internal reasons:
- Hereditary tendency to hallux valgus
- horizontal and longitudinal flat base
- inflammatory processes (especially arthritis: psoriatic arthropathy, gout, rheumatoid arthritis)
- congenital biomechanical instability of the foot
- hyperelastic syndrome, connective tissue dysplasia
- neuropathy of various origins
- deformation of the knee and hip joints
External factors that provoke:
- injuries with sprained foot and ankle ligaments, joint damage and foot fractures
- wearing anatomically incorrect high-heeled shoes with narrow toes
- occupational risk: carrying heavy objects for a long time, standing for a long time
Hereditary tendency to Hallux valgus in itself is not considered the cause of the development of the disease, but is an increased risk factor that almost always triggers under negative external factors.
What happens with hallux valgus
Valgus deformity- not only an aesthetic defect, which causes women a lot of trouble due to restrictions in the choice of shoes (this disease is more common in women than in men).Changes occur in the entire musculoskeletal system of the foot, which gradually develops and after a while enters an irreversible stage.What happened to the legs?
- Spreading the legs, changing the shape of the anatomy, reducing the bend.
- Displacement of the first metatarsal bone and increased angle between it and the second metatarsal bone.
- Deviation of the big toe at an angle to the first metatarsal bone, the head of which is shaped like a protruding lump (therefore, Hallux valgus is often called a lump or bunion).
- Subluxation of the metatarsophalangeal joint, which leads to rotation of the sesamoid bone.
- Violation of biomechanical indicators: decreased indicators of motor function and support.
- Changes in bones, cartilage tissue and all joints.First of all, the area of the head of the first metatarsal bone suffers: the tissue becomes more sensitive, the bone becomes inflamed and painful, bursitis can develop, and the cartilage is destroyed.The lumen of the joint space narrows, focal cystosis develops with local osteoporosis.
Hallux valgus symptoms
The disease does not develop in a week or a month;from the beginning of clearly visible pathology (at stage I, the toe deviates from the normal position by 20-30°) to the third stage of hallux valgus (the big toe deviates more than 40° and is usually superimposed on the second) can take more than a decade.
External manifestations of the disease:
- Deviation of the big toe to the side (outward from the inner surface of the foot) and bony prominence.
- Hammer-shaped feet (the 2nd and 3rd toes are deformed and become hammer-like, that is, they are bent at the joints).
- Leg fatigue, pain, which often increases in the evening and at night.
Diagnostics
The diagnosis is made based on the data obtained during the external examination and x-ray of the foot.To find out the reasons for the development of the disease, the orthopedist collects an anamnesis (during the conversation, he asks the patient about his occupation, hereditary diseases, previous injuries, lifestyle, habits), provides referrals for laboratory tests, and consults with other specialists.The fact is that hallux valgus can be caused by autoimmune and systemic diseases (for example, rheumatoid arthritis), metabolic disorders, and neurological disorders.After examination, in which concomitant diseases are often diagnosed, treatment is prescribed.
Treatment methods for hallux valgus
In the initial stages of the disease (hallux valgus grade 1), conservative treatment is prescribed: gymnastics, wearing individual orthopedic insoles to prevent flat feet, massage, foot baths, and medications.It is also recommended to wear elastic fixators (protecting the head of the first metatarsal bone), called valgus splints.For inflammation, physiotherapeutic treatment is prescribed: magnetotherapy, electrophoresis, paraffin therapy, etc., painkillers.
The orthopedist, if necessary, will give recommendations on changes in lifestyle and diet.For example, many patients need to switch to diet food to reduce excess weight and not provoke disease.It is also advised to limit excessive physical activity, often walk barefoot on the ground and small stones, use orthopedic mats, buy safe shoes that do not squeeze the toes, which cause the legs not to bend, and the center of gravity of the whole body does not move.
However, all conservative methods can only slow down the course of the disease, but not get rid of it forever.Therefore, in difficult cases, surgical treatment is prescribed.More than 100 different proprietary methods for the treatment of hallux valgus have been developed.All are based on osteotomy of the distal and proximal angles with reconstruction of the foot to correct the deformity.To perform the surgery, the first metatarsophalangeal joint is exposed through an incision in the skin.Next, the surgeon cuts the bone and places it in a position that works properly.With the help of osteotomy, you can not only correct the deformation due to finger deviation, but also lengthen or shorten the bone if there is a concomitant pathology.As a result, it is possible to achieve a long level of compensation or completely eliminate pathology, maintain or restore joint function.
Basic methods of surgical correction of hallux valgus:
- Corrective osteotomy of the first metatarsal bone (chevron, wedge-shaped, SCARF+Akin (with resection and rotation), Lapidus arthrodesis.
- Osteotomy using bioabsorbable implants.
The final choice of treatment method can be made only after examination and determination of the degree of deformation and individual clinical and radiological picture.
After the corrective osteotomy, the supporting function is restored, pain disappears, corns and calluses do not form, soft tissues do not swell, all components of the deformation are eliminated: the fingers return to their anatomically correct place, the cartilage is not destroyed, and the joint is not deformed.Patients can lead a full life, play sports, walk, run, and wear comfortable shoes.